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WELCOME An Introduction to IHI Penny Carver Senior Vice President. Carnegie Foundation Knowledge Alliance Working Meeting January 20, 2010. IHI Mission.

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welcome an introduction to ihi penny carver senior vice president

WELCOMEAn Introduction to IHIPenny CarverSenior Vice President

Carnegie Foundation

Knowledge Alliance Working Meeting

January 20, 2010

ihi mission
IHI Mission

The Institute for Healthcare Improvement is a not-for-profit organization driving the improvement of health by advancing the quality and value of health care.

why we exist
Why We Exist

“Between the health care we have and the care we could have lies not just a gap, but a chasm.”

- Institute of Medicine, Crossing the Quality Chasm, 2001

defects for example
Defects….for example…
  • 45% of needed care is not received
  • 22% of chronically ill adults report a “serious error” in their care
  • 74% of chronically ill adults say the system needs “fundamental change” or “complete rebuilding”
  • Case-mix adjusted hospital death rates vary 400%
  • Resource use in the last six months of life varies >500% among 77 top-rated US hospitals
  • Per capita annual health care costs:
    • US: ~$6000
    • Sweden: ~$2800
variation in practice
Variation in Practice

Hysterectomy by age 70

Prostatectomy by age 85

70

60

50

40

30

20

10

0

Main

Maine

Maine

Maine

Iowa

Iowa

Iowa

Iowa

hospital

hospital

hospital

hospital

hospital

hospital

hospital

hospital

international comparison of spending on health 1980 2005
International Comparison of Spending on Health, 1980–2005

Average spending on healthper capita ($US PPP*)

Total expenditures on healthas percent of GDP

* PPP=Purchasing Power Parity.

Data: OECD Health Data 2007, Version 10/2007.

8

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008

our blueprint the iom s six aims
Our Blueprint: the IOM’s Six Aims
  • Safe – no needless deaths
  • Effective– no needless pain or suffering
  • Patient-Centered – no helplessness in those served or serving
  • Timely– no unwanted waiting
  • Efficient– no waste
  • Equitable – for all
we do this by
We Do This By…
  • Building the will for change
  • Cultivate promising improvement ideas
  • Putting those ideas into action through effective execution

“Improvement of any system requires will, ideas and execution.”

- Tom Nolan, PhD

slide12

Institute for Healthcare Improvement2010 IHI Strategic Plan

WHO WE ARE

We are a reliable source of energy, knowledge, and support for a never-ending campaign to improve health and health care worldwide.

WHAT WE WILL ACCOMPLISH

In the US and abroad, we will improve the lives of patients, the health of communities, and the joy of the health care workforce, and reduce health care costs. We work with health care providers and others to accelerate the measurable and continual progress of health care systems throughout the world toward Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity.

WHAT WE WILL BECOME

We will be a recognized and generous leader, a trustworthy partner, and the first place to turn for expertise, help, and encouragement for anyone, anywhere who wants to change health care fundamentally for the better.

Strategy #1: Motivate

Stimulate the desire and optimism for change

Strategy #3: Get Results

Ensure wide adoption of sound changes

Strategy #2: Innovate

Create, find and test new models of care

Strategy #4: Raise Joy in Work

Help build a better health care workforce

A. Publicize widely the case for improvement, promising designs and impressive results

B. Publish widely in peer-reviewed journals

C. Ally with influential organizations that share our aims to amplify our effectiveness

D. Influence the national health policy debate

A. Discover health care processes and systems that will deliver better outcomes and lower costs

B. Demonstrate the efficacy of new models and codify content in preparation for spread

A. Convene and manage vibrant networks, communities and partnerships to deploy proven changes rapidly

B. Disseminate health care improvement ideas and methods through world-class learning events

C. Create and expand a world-class web presence to propel the spread and adoption of improvements at very low cost

A. Ensure that young health professionals are prepared for effective participation in improvement

B. Ensure that executives, boards, and relevant public officials are prepared to support improvement

C. Develop and nurture a cadre of improvement leaders

Strategy #5: Stay Vital for the Long Haul

Sustain IHI’s viability

A. Continually improve IHI’s leadership system and plan for succession

B. Make IHI the best place to work in the eyes of its employees and faculty

C. Maintain a sound operating margin, continually reduce overhead costs

D. Raise funds reliably to help support unfunded community benefits

the first law of improvement
“Every System Is Perfectly Designed to Achieve Exactly the Results It Gets”

(Therefore, although not all change is improvement, all improvement Is change)

The First Law of Improvement
model for improvement

What are we trying to accomplish?

How will we know that a change is an improvement?

What changes can we make that will result in an improvement?

Act

Plan

Study

Do

Model for Improvement
repeated use of the cycles

DATA

A

P

S

D

Repeated Use of the Cycles

Changes that

Result in

Improvement

A

P

S

D

A

P

S

D

A

P

S

D

Hunches

Theories

Ideas

multiple pdsa cycle ramps

P

P

P

P

A

A

A

A

D

D

D

D

S

S

S

S

S

D

S

S

S

D

D

D

A

P

A

A

A

P

P

P

A

A

A

A

P

P

P

P

S

S

S

S

D

D

D

D

P

P

P

P

A

A

A

A

D

D

D

D

S

S

S

S

Multiple PDSA Cycle Ramps

Testing and adaptation

Triage

Diagnostic

Testing

Fast Track

Patients

Capacity/

Demanding

Change Concepts

the social system

The Social System

Breakthrough Series Collaboratives

the breakthrough series

P

P

A

D

A

D

S

S

The Breakthrough Series

Participants

Select Topic

Prework

Printed Reports

Change Concepts

National

Congress

LS 1

LS 2

LS 3

Expert Group

Supports

Visits

Documents

E-mail

Phone

Assessments

pursuing perfection
Pursuing Perfection

An IHI program funded by The Robert Wood Johnson Foundation to improve patient outcomes dramatically by pursuing perfection in all of the major care processes. Pursuing perfection means striving to:

  • Deliver all indicated services at the right time;
  • Avoid services that are not helpful to the patient or reasonably cost effective;
  • Avoid safety hazards and errors that harm patients and employees; and
  • Respect patients’ unique needs and preferences.  

January 2001-April 2006

unnecessary hospital deaths developing a learning system
Unnecessary Hospital Deaths: Developing a Learning System
  • Do people die unnecessarily every single day in our hospitals?
  • In order for us to understand this, we need a diagnostic journey that moves out of a model for judgment and into a model for learning.
  • New model: - What can we learn from the deaths? - Was perfect care given?
  • You need to get a clearer understanding of local conditions that contribute to mortality.
areas of improvement that we are focusing on
Areas of Improvement That We are Focusing On
  • Box 3 Changes (ICU)
    • Ventilator Bundle
    • Central Line Bundle
    • Multidisciplinary Rounds/Shared Goal Sheet
    • Glycemic Control
    • Sepsis Bundle and detection
    • Appropriate tidal volume for ARDS/Acute Lung Injury patients - very early work for us
areas of improvement that we are focusing on1
Areas of Improvement That We are Focusing On
  • Box 4 Changes (non-ICU)
    • Rapid Response Team
    • Improved communication
      • SBAR
      • Shift handoffs
    • Early Warning System
    • Multidisciplinary Rounds outside the ICU
    • Glycemic Control outside of ICU
    • Crew Resource Management Training
the campaign planks six changes that save lives
The Campaign “Planks” -- Six Changes That Save Lives
  • Deployment of Rapid Response Teams
  • Delivery of Reliable, Evidence-Based Care for Acute Myocardial Infarction
  • Medication Reconciliation
  • Prevention of Central Line Infections
  • Prevention of Surgical Site Infections
  • Prevention of Ventilator-Associated Pneumonias
six additional planks
Six Additional Planks
  • Prevent Pressure Ulcers
  • Reduce Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection
  • Prevent Harm from High-Alert Medications
  • Reduce Surgical Complications (the Surgical Care Improvement Project (SCIP))
  • Deliver Reliable, Evidence-Based Care for Congestive Heart Failure
  • Get Boards on Board
ihi programs
IHI Programs
  • The Improvement Map
  • WIHI
  • STAAR
  • Safer Patients Network
  • Scottish Patient Safety Programme (SPSP)
  • Triple Aim
  • How Do They Do That?
  • R&D
  • The IHI Open School
slide35

Builds on the great work of participants in the 100,000 Lives Campaign and the 5 Million Lives Campaign.

  • “Help us make sense of the many complex and competing demands we face.”
  • Brings together the best knowledge available on the key process improvements that will lead to exceptional hospital care. 
  • Helps hospital leaders set change agendas, establish priorities, organize work, and optimize resources.
  • An open resource, available free of charge to anyone, anywhere.
  • Launched on September 15, 2009.
safer patients initiative an ihi program funded by the health foundation
Safer Patients Initiative An IHI Program Funded by The Health Foundation
  • The 100,000 Lives Campaign was built around 6 interventions
  • The Safer Patients Initiative combined 5 of the “Campaign 6” plus 10 other change elements
  • Phase 1: Four acute hospital trusts – Wales, Northern Ireland, England, and Scotland
safer patients initiative multiple centers of gravity
Safer Patients Initiative Multiple “Centers of Gravity”
  • The SPI change package addresses five clinical areas:
  • - Medicines management
  • - Infection prevention and control
  • - Peri-operative care
  • - Critical care
  • - Care on general wards
  • All supported by an organisational wide effort to bring about a change in culture working at all levels but with a key role for senior leaders
the triple aim
The “Triple Aim”
  • Improve Individual Experience
  • Improve Population Health
  • Control Inflation of Per Capita Costs

The root of the problem in health care is that the business models of almost all US health care organizations depend on keeping these three aims separate. Society on the other hand needs these three aims optimized (given appropriate weightings on the components) simultaneously.

--- (Tom Nolan, PhD)

how do they do that low cost high quality care
How Do They Do ThatLow-Cost, High-Quality Care
  • July 21, 2009: Meeting in Washington, DC with Don Berwick, Elliott Fisher, Atul Gawande and Mark McClellan
    • Involving health care leaders from a select group of high-performing regions of the U.S. to share their experiences
    • Sponsored by the Institute for Healthcare Improvement, The Dartmouth Institute for Health Policy and Clinical Practice, the Harvard School of Public Health, and the Engelberg Center for Health Care Reform at The Brookings Institution
much has been learned price adjusted per capita medicare spending 2006

$10,250

to

17,184

(55)

9,500

to <

10,250

(69)

8,750

to <

9,500

(64)

8,000

to <

8,750

(53)

6,039

to <

8,000

(65)

Not Populated

Much has been learnedPrice-adjusted per-capita Medicare spending 2006
90 day project topics november 2009 janurary 2010
90-Day Project Topics November 2009-Janurary 2010

Hospital Projects

  • Waste Reduction Tool
  • Financial Implications for Hospitals of Reduce Readmissions
  • Learning from Specialty Care and ED Use Prototyping
  • Work Place Safety Program Development
  • Other Hospital Waste and Cost Reduction Projects as needed

Triple Aim Projects

  • Triple Aim in a Region
  • Improvement at a Country Level
  • Connecting and Activating Community Health Care and Other Resources
  • Socially Complex Patients
slide45

The IHI Open School Mission

“Advance health care improvement and patient safety competencies

in the next generation of health professionals worldwide.”

progress
Progress
  • Registration
    • Over 20,000 students registered on IHI.org
    • Over 6,000 faculty and deans registered on IHI.org
  • Online courses
    • Over 20,000 courses completed (50% students, 50% professionals)
    • Available: 6 Quality Improvement, 3 Patient Safety, 1 Leadership
  • Online Resources
    • Over 30,000 downloads of case studies, glossaries, exercises, activities
    • Over 58,000 downloads of audio and video recordings
  • Online Community
    • YouTube, Facebook, Blog, Twitter
slide48

IHI Open School Chapters

173

Chapters

  • 173 Chapters on 185 campuses
  • 119 US Chapters in 40 states
  • 54 International Chapters in 24 countries
experiential learning
Experiential Learning
  • Projects initiated by students
    • WHO Surgical Checklist Student Project
  • Projects initiated by faculty
    • Beverly Hospital Chapter
  • Projects initiated by the IHI Open School team
    • Shadowing students of another health profession
so where will ihi lead
So Where Will IHI Lead?
  • To meet the challenge of moving the “big dots”
  • To create new, more effective designs
  • To ensure deep results and broad reach
  • To restore joy and confident capability
ihi values
IHI Values

Cooperation and Boundarylessness

Our culture is team-oriented, and we all learn from and teach each other. We are an organization without walls that welcomes members of our team who are not based in Boston to be fully included in and informed about our day-to-day work.

Patient and Health Care Focus

We focus our energies primarily on content areas that will improve the lives of patients.

Speed and Agility

We anticipate customer needs and develop solutions that address those needs quickly and efficiently.

Customer Focus

We anticipate customer needs and develop programs that address those needs quickly and efficiently. We will know we have succeeded when customers can measure results and value from our interactions.

ihi values1
IHI Values

Valuing Volunteers

We will continually delight the faculty and associates with whom we work.

Honesty and Transparency

We will be honest and open about our successes and failures, and will thereby be worthy of trust.

Orderliness

We will continuously improve our leadership and management by developing innovative processes and eliminating waste.

Celebration and Thankfulness

We celebrate our work and thank publicly and privately those that bring about our successes.

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